Please rate your current level of satisfaction with each of the following areas of your life. Place a number from 1 to 10 in the box next to each item, 1 meaning “entirely unacceptable to me in its current state”and 10 meaning “I couldn’t be happier with this”. Skip any that do not apply. Your level of satisfaction with each may change somewhat from day to day, but try to give your best overall assessment of how pleased/peaceful/fulfilled/content you are with each at this point in your life. 

Personal Spiritual Life and Growth ________

Church/Religious Life ________

Physical Health ________

Mental/Emotional Health ________

Marriage/Romantic Relationship ________

Home Life (Family Cohesion –How the Family “Works”) ________

Personal Order (Organization, Efficiency, Simplicity) ________

Extended Family Relationships (Relatives, In-laws) ________

Friends/Social Life ________

Fun and Recreation/Hobbies ________

Financial Stability ________

Physical Environment (Condition of Home, Cars, Neighborhood, etc.) ________

Career/Employment ________ 

Relationship with family member __________________________ ________ (List Each Separately) 

One Another Ministries International,